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Insufficiency of the anterior cruciate ligament

Review of our 118 cases

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Summary

Recurrent anterior and internal rotatory subluxation of the tibial plateau is a disabling symptom in patients with insufficiency of the anterior cruciate ligament.

Since 1970 we have used the N-test, a special jolt test to detect the characteristic instability. One hundred eighteen cases with anterior-internal rotatory instability of the knee seen at the Kanto Rosai Hospital and the University of Tokyo Hospital and diagnosed by arthroscopy and arthrotomy from 1973 to 1978 were reviewed. Most of the patients were athletes or sportsmen and the injuries commonly occurred in deceleration-injury mechanism and 81% of the cases were associated with meniscal tear.

Thirty-two cases were reconstructed by iliotibial tract transfer, twenty of whom had been evaluated from 1–5 years after operation. Postoperatively, giving-way incidents disappeared in eleven, markedly decreased in five, and were unchanged in four patients. The anterior and internal rotatory subluxation of the tibial plateau disappeared or decreased in seventeen and was unchanged in two cases.

Some type of defective anterior cruciate ligament was recognized in all our 118 cases and the capsular lesions were considered to play only a secondary role in exhibiting the instability.

Zusammenfassung

Die periodisch rezidivierende Subluxation des Tibiakopfes nach vorne and innen ist ein charakteristisches Syndrom bei Patienten mit einer Insuffizienz des vorderen Kreuzbandes. Um these Instabilitat ermitteln zu können, verwenden wir seit 1970 den sogenannten “N-Test”, eine von uns entwickelte Variante des “Pivot-shift”-Testes.

Im Kanto Rosai Hospital und in der Universitätsklinik Tokio konnten von 1973–1978 118 Fälle mit dieser Instabilitat untersucht and durch Arthroskopie und Arthrotomie diagnostisch gesichert werden. Die Mehrzahl der Patienten waren Sportler, bei denen es bei Decelerationsmechanismen zum Unfall kam. In 81% der Fälle lag gleichzeitig ein Meniskusriß vor. Von 32 durch Verlagerung des Tractus iliotibialis behandelten Patienten werden 20 1–5 Jahre post operationem nachuntersucht. In 11 Fällen verschwand das „giving-way”, das unsichere, plötzliche Nachgeben im Knie vollständig; in 5 Fällen nahm es deutlich ab und nur 4mal blieb es unverändert. In 17 Fällen verschwand oder verringerte sich die Rotationssubluxation nach vorne and innen und nur in 2 Fällen trat keine Veränderung ein. Ein Defekt des vorderen Kreuzbandes wurde in all unseren 118 Fällen festgestellt wohingegen Kapselverletzungen beim Zustandekommen der Instabilität als zweitrangig angesehen werden.

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References

  1. Bruckner H. Eine neue Methode der Kreuzbandplastik. Chirurg 37, 413–414 (1966)

    PubMed  Google Scholar 

  2. Fukubayashi, T., Suzuki, K., Nakajima, H., Kondo, M., Koide, S., Nagasaka, Y., Kurosawa, H., Koga, S., Doi, T., Shi, K.: Prognosis of menisectomy associated with insufficiency of the anterior cruciate ligament. Traumatology 19, 805–810 (1976) (Japanese)

    Google Scholar 

  3. Galway, R. D.: Lateral pivot shift injury of the knee. J. Bone Jt. Surg. 53-B, 772–773 (1971)

    Google Scholar 

  4. Hey-Groves, E. W.: The crucial ligaments of the knee joint. Br. J. Surg. 7, 505–515 (1920)

    Google Scholar 

  5. Hughston, J. C., Andrews, J. R., Cross, M. J., Moschi, A.: Classification of knee ligament instabilities. J. Bone Jt. Surg. 58-A, 159–179 (1976)

    Google Scholar 

  6. Jones, K. G.: Reconstruction of the anterior cruciate ligament. Br. J. Surg. 7, 592–602 (1920)

    Google Scholar 

  7. Kettelkamp, D. B., Johnson, R. J., Smiat, G. L., Chao, E. Y. S., Walker, M.: An electrogoniometric study of knee motion in normal gait. J. Bone Jr. Surg. 52-A, 775–790 (1970)

    Google Scholar 

  8. Kennedy, J. C., Stewart, R., Walker, D. M.: Anterolateral rotatory instability of the knee joint. J. Bone Jt. Surg. 60-A, 1031–1039 (1978)

    Google Scholar 

  9. Kurosawa, H., Fukubayashi, T., Chang, E., Koga, S., Doi, T., Nakajima, H., Kondo, M., Kabata, K.: New diagnostic techniques and N-test for unstable knees. Traumatology 21, 949–957 (1978) (Japanese)

    Google Scholar 

  10. Lam, S. J. S.: Reconstruction of the anterior cruciate ligament using the jones procedure and it's Guy's Hospital modification. J. Bone Jt. Surg. 50-A, 1213–1224 (1963)

    Google Scholar 

  11. Losee, R., E., Johnson, E. T. R., Southwick, W. O.: Anterior subluxation of the lateral tibial plateau. J. Bone Jt. Surg. 60-A, 1015–1030 (1978)

    Google Scholar 

  12. Murray, M. P., Draught, B., Kory, R. C.: Walking patterns of normal men J. Bone Jt.Surg. 46-A, 335–360 (1964)

    Google Scholar 

  13. Nakajima, H.: Instability of the knee in a special position. The 24th Japanese Congress of Physical Fitness and Sports Medicine, Iwate, October 1970

  14. Nakajima, H.: Internal derangement of the knee as athletic injuries. The 21st Congress of Eastern Japanese Clinical Orthopaedics, Tokyo, August 1972

  15. Nakajima, H.: Internal derangement of the knee as athletic injuries. J. Jap. Orthop. Ass. 47, 398–399 (1973) (Japanese)

    Google Scholar 

  16. Nakajima, H., Kurosawa, H., Nakagawa, T., Shindo, H., Koide, S., Kondo, M.: Correlation between the anterior cruciate ligament and meniscal injuries. J. Jap. Orthop. Ass. 47, 1272–1273 (1973) (Japanese)

    Google Scholar 

  17. Nakajima, H.: Internal derangement of the knee. Orthop. Surg. 24, 373–378 (1973) (Japanese)

    Google Scholar 

  18. O'Donoghue, D. H.: A method for replacement of the anterior cruciate ligament of the knee. J. Bone Jt. Surg. 45-A, 905–924 (1963)

    Google Scholar 

  19. Palmer, L: On the injuries to the ligaments of the knee joint. Acta Chir. Scand. Suppl. 53 (1938)

  20. Slocum, D. B., Larson, R. J.: Pes anserinus transplantation. J. Bone Jt. Surg. 50-A, 226–242 (1968)

    Google Scholar 

  21. Slocum, D. B., James, S. L., Larson, R. L., Singer, K. M.: Clinical test for anterolateral rotatory instability of the knee. Clin. Orthop. 118, 63–69 (1976)

    PubMed  Google Scholar 

  22. Smillie, I. S.: Injuries of the knee joint. Second ed., pp.200–204. Edingburgh: E & S, Livingstone LTD, 1951

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kizukisumiyoshi-cho, Nakahara-ku, Kanagawa-ken

    Hiroyuki Nakajima M.D. & Minoru Kondo

  2. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan

    Hisashi Kurosawa & Toru Fukubayashi

Authors
  1. Hiroyuki Nakajima M.D.
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  2. Minoru Kondo
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  3. Hisashi Kurosawa
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  4. Toru Fukubayashi
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Read in part at the SICOT Meeting, Kyoto, 1978

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Nakajima, H., Kondo, M., Kurosawa, H. et al. Insufficiency of the anterior cruciate ligament. Arch. Orth. Traum. Surg. 95, 233–240 (1979). https://doi.org/10.1007/BF00389691

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  • DOI: https://doi.org/10.1007/BF00389691

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